Rural and safety net hospitals prepare for cut in federal support November 11, 2019 Stateline from Pew Trusts Share Tweet SUMMARY: Stateline from Pew Trusts is reporting that rural hospitals in states that failed to expand Medicaid are feeling the squeeze of federal cuts – putting the communities they serve at risk. Rural and safety net hospitals run on very tight margins both in North Carolina and nationally and expected cuts in federal aid could severely limit the ability to serve local patients. In-depth reporting from Stateline from Pew Trusts suggests that rural hospitals are under extreme duress in the face of potential cuts in federal funding. Since 1981, the federal government has been helping pay for uncompensated care provided by hospitals, but with the promise of Medicaid expansion in the Affordable Care Act it was expected that there would be far fewer patients without insurance, and therefore less uncompensated care costs for rural and safety net hospitals. In states that have not followed through on Medicaid expansion, like North Carolina, there is additional pressure on rural and safety net hospitals, and they may not be able to continue to offer their current levels of service if the cuts go into place.